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Radiological Investigation III: Pulmonary Angiogram and PET Scan01:13

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Radiological investigations are paramount in the diagnosis and management of various pulmonary diseases. Two essential investigations are the Pulmonary Angiogram and the Positron Emission Tomography (PET) Scan.
Pulmonary Angiogram
A Pulmonary Angiogram is an invasive procedure involving injecting a contrast medium through a catheter threaded into the pulmonary artery or the right side of the heart to visualize the pulmonary vasculature. Computed Tomography (CT) scans have mainly replaced this...
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Radiologist- and computer-based chest imaging quantification at 12 months post transplant correlates with baseline

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Baseline lung allograft dysfunction (BLAD) after lung transplant is linked to poor survival. Computer-aided CT scans reveal structural changes, with CT-measured total lung capacity and pulmonary vessel volume being key predictors of BLAD.

Keywords:
Baseline lung allograft dysfunctionComputed tomographyLung transplantMachine learningPulmonary vessel volume

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Area of Science:

  • Pulmonary Medicine
  • Radiology
  • Transplant Surgery

Background:

  • Baseline lung allograft dysfunction (BLAD) is defined as spirometry <80% predicted post-lung transplant.
  • BLAD is associated with reduced patient survival.
  • The CT imaging characteristics of BLAD require further elucidation.

Purpose of the Study:

  • To determine the prevalence of CT abnormalities in BLAD.
  • To characterize radiologic findings associated with BLAD.
  • To identify CT features that predict BLAD.

Main Methods:

  • Retrospective cohort study of adult double-lung transplant recipients (12/2017-10/2021).
  • Radiologist assessment of CT scans for GGO, reticulation, consolidation, effusion, bronchiectasis, and air-trapping.
  • Machine learning-based CT radiomics (CT-measured total lung capacity [CTTLC], pulmonary vessel volume [PVV]) and parametric response mapping for functional small airways disease.

Main Results:

  • BLAD patients (46%) showed longer intubation, hospitalization, and lower donor-to-recipient TLC ratio.
  • Radiologist review found more pleural effusions in BLAD; computer-aided CT showed more reticulation, GGO, and parenchymal density.
  • Lower CTTLC and higher PVV were observed in BLAD. PVV was a significant predictor of BLAD (OR=2.65).

Conclusions:

  • Computer-aided CT detects structural changes in BLAD missed by standard radiologist review.
  • CTTLC and PVV are strong radiologic predictors of BLAD.
  • These findings suggest restrictive physiology and vascular remodeling in BLAD.